Adverse pathology and undetectable ultrasensitive prostate‐specific antigen after radical prostatectomy: is adjuvant radiation warranted?

Simon, Ross; Howard, Lauren E.; Freedland, Stephen J.; Aronson, William J.; Terris, Martha K.; Kane, Christopher J.; Amling, Christopher L.; Cooperberg, Matthew R.; Vidal, Adriana C.

doi:10.1111/bju.13182

Cited by 8 publications

(6 citation statements)

References 35 publications

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“…of patients Recruitment period Age (years) p-PSA (ng/ml) Follow-up (months) Surgical approach Wettstein et al [ 35 ] 2017 Switzerland 371 2008–2015 Median (range) 63 (41–78) Median (range) 6.79 (0.43–81.4) Median (range) 28 (1–64) NA Xun et al [ 6 ] 2017 China 172 2003–2014 Median (IQR) 68 (62–72) Median (IQR) 16.1 (10.9–28.3) Median (IQR) 46.4 (33.4–62.4) NA Meyer et al [ 36 ] 2017 Germany 903 1992–2005 Median (IQR) 63 (59–66) Median (IQR) 6.4 (4.6–9.0) Median (IQR) 133 (97–157) NA Gandaglia et al [ 37 ] 2017 Multi-centred 94 2011–2015 Median (IQR) 64.3 (57.1–68.9) Median (IQR) 9.7 (5.1–17.5) Median (IQR) 23.5 (18.7–27.3) Robot-assisted RP Shangguan et al [ 33 ] 2016 China 172 2003–2014 Median (range) 68 (62–72) Median (range) 16.1 (10.9–28.3) Median (IQR) 46.4 (33.4–62.4) Open and laparoscopic RP Zhang et al [ 34 ] 2016 China 168 2006–2011 Median (range) 69 (53–85) Median (range) 13.31 (4.59–36.12) Median (range) 68 (7–98) Laparoscopic RP Simon et al [ 12 ] 2016 Multi-centres 411 2001–2013 …”

Section: Methodsmentioning

confidence: 99%

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Positive surgical margin is associated with biochemical recurrence risk following radical prostatectomy: a meta-analysis from high-quality retrospective cohort studies

Zhang

Zha

et al. 2018

World J Surg Onc

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Background and purposeAlthough numerous studies have shown that positive surgical margin (PSM) is linked to biochemical recurrence (BCR) in prostate cancer (PCa), the research results have been inconsistent. This study aimed to explore the association between PSM and BCR in patients with PCa following radical prostatectomy (RP).Materials and methodsIn accordance with the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), PubMed, EMBASE and Wan Fang databases were searched for eligible studies from inception to November 2017. The Newcastle–Ottawa Scale was used to assess the risk of bias of the included studies. Meta-analysis was performed by using Stata 12.0. Combined hazard ratios (HRs) and their corresponding 95% confidence intervals (CIs) were calculated using random-effects or fixed-effects models.ResultsUltimately, 41 retrospective cohort studies of high quality that met the eligibility criteria, comprising 37,928 patients (94–3294 per study), were included in this meta-analysis. The results showed that PSM was associated with higher BCR risk in both univariate analysis (pooled HR = 1.56; 95% CI 1.46, 1.66; p < 0.001) and multivariate analysis (pooled HR = 1.35; 95% CI 1.27, 1.43; p < 0.001). Moreover, no potential publication bias was observed among the included studies in univariate analysis (p-Begg = 0.971) and multivariate analysis (p-Begg = 0.401).ConclusionsOur meta-analysis demonstrated that PSM is associated with a higher risk of BCR in PCa following RP and could serve as an independent prognostic factor in patients with PCa.Electronic supplementary materialThe online version of this article (10.1186/s12957-018-1433-3) contains supplementary material, which is available to authorized users.

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Section: Methodsmentioning

confidence: 99%

“…Although PSM is frequently reported in radical prostatectomy series, their clinical relevance remains uncertain despite extensive investigation. A number of studies have demonstrated an association between PSM and BCR [ 5 , 10 , 11 ], while others have observed insignificant or even contrary correlations [ 12 – 14 ].…”

Section: Introductionmentioning

confidence: 99%

Positive surgical margin is associated with biochemical recurrence risk following radical prostatectomy: a meta-analysis from high-quality retrospective cohort studies

Zhang

Zha

et al. 2018

World J Surg Onc

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“…Of these, PSM is the most important predictive factor for BCR (6)(7)(8)(9)(10)(11)(12)(13). Certain patients with PSM have favorable prognosis after undergoing surgery alone, while others require salvage therapy immediately after surgery and have poor prognosis (14)(15)(16). Therefore, patients with PSM are considered to be a highly diverse group and the significance of PSM after RP remains controversial.…”

Section: Introductionmentioning

confidence: 99%

Impact of Gleason score of the tumor at the positive surgical margin as a prognostic factor

et al. 2022

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Although numerous studies have reported that a positive surgical margin (PSM) is the most important predictive factor for biochemical recurrence (BCR) of prostate cancer (PCa), only a small number of studies have evaluated the predictive value of the Gleason score (GS) of the tumor at the margin in radical prostatectomy (RP). The present study aimed to investigate the preoperative factors that predict PSM and the significant predictive factors for BCR in cases with PSM. In addition, it was examined whether documenting the GS of the tumor at the margin in pathological reports is useful as a predictive factor for BCR. Data of 241 patients with PCa who underwent RP at Kurume University Hospital (Kurume, Japan) between January 2007 and December 2011 were retrospectively reviewed. The median follow-up period was 72 months and 122 patients had at least one PSM. The time to BCR was significantly shorter in patients with PSM than in those with a negative surgical margin. Multivariate analysis demonstrated that >10 ng/ml prostate-specific antigen at diagnosis (P=0.024) and >25% positive core at biopsy (P=0.041) were independent prognostic preoperative factors for PSM. The GS of the tumor at the margin was equal, lower and higher than those of the main tumor in 74 (60.7%), 16 (13.1%) and 32 (26.2%) RPs, respectively. The BCR rates were 35.7, 55.1 and 82.1% in patients whose GS of the tumor at the margin was 6, 7 and 8-10, respectively (P=0.0017). The GS of the tumor at the PSM (P=0.038) and anatomic location of the PSM (P=0.04) were identified as independent prognostic preoperative factors for BCR, whereas the GS of the main tumor and margin length were not. These results suggest that documenting the GS at the margin in pathological reports is useful as a predictive factor for BCR.

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“…Periodic measurement of serum PSA levels after RP can identify disease recurrence at an early stage so that additional treatment such as radiation therapy or androgen deprivation therapy (ADT) can be initiated. There are many patients, however, who would benefit from adjuvant radiation or ADT immediately after RP to prevent the recurrence of ultimately fatal disease . Pathological analysis of the primary tumour is conducted to identify features that indicate the cancer may have metastatic potential, such as invasion of the seminal vesicles or lymph nodes, and extracapsular extension, in addition to the presence of more poorly differentiated tissue architecture as described according to the Gleason grading system.…”

Section: Introductionmentioning

confidence: 99%

Evaluation of a 24‐gene signature for prognosis of metastatic events and prostate cancer‐specific mortality

et al. 2017

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OBJECTIVES To determine the prognostic potential of Sig24 for identifying prostate cancer patients at risk of developing metastases or experiencing PCSM following radical prostatectomy. SUBJECTS AND METHODS Sig24 scores were calculated from previously collected gene expression microarray data from the Cleveland Clinic and Mayo Clinic (I and II). The performance of Sig24 was determined using time-dependent c-index analysis, Cox proportional hazards regression and Kaplan-Meier survival analysis. RESULTS Higher Sig24 scores were significantly associated with higher pathologic Gleason scores (GS) in all three cohorts. Analysis of the Mayo Clinic II cohort, which included time to event information, indicated that patients with high Sig24 scores also had an increased risk of developing metastasis (HR: 3.78, 95% CI: 1.96–7.29, p < 0.001) or experiencing PCSM (HR: 6.54, 95% CI: 2.16–19.83, p < 0.001). CONCLUSIONS The findings of this study demonstrate the applicability of Sig24 for the prognosis of metastasis or PCSM following radical prostatectomy. Future studies investigating the combination of Sig24 with available prognostic tests may provide new approaches to improve risk stratification for patients with prostate cancer.

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Adverse pathology and undetectable ultrasensitive prostate‐specific antigen after radical prostatectomy: is adjuvant radiation warranted?

Cited by 8 publications

References 35 publications

Positive surgical margin is associated with biochemical recurrence risk following radical prostatectomy: a meta-analysis from high-quality retrospective cohort studies

Positive surgical margin is associated with biochemical recurrence risk following radical prostatectomy: a meta-analysis from high-quality retrospective cohort studies

Impact of Gleason score of the tumor at the positive surgical margin as a prognostic factor

Evaluation of a 24‐gene signature for prognosis of metastatic events and prostate cancer‐specific mortality

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